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Considerations for operations during renovations

Involvement and communication during construction are key. During the phased consolidation of Parkview Medical Center’s imaging department, staff members were included in the process. Images were displayed in common areas highlighting the new views, as well as the new equipment.

Amy Dvorak, Associate AIA
Communications manager, Treanor HL

Hospitals are complex. Renovating hospitals is even more complex. Take into consideration existing medical systems, heat loads and major utility shutoffs – not to mention the utmost priority that is patient care – in a dust-free, soundfree environment that seamlessly continues uninterrupted patient care. To do it well takes a village.

“In hospitals, you’re dealing with a very different population,” said Nandini Biesk, associate in the health studio at TreanorHL. “You’re disrupting care of the patients, and if you’re not doing it right, it can cost them their lives.” And hospitals know the risk, going so far as to delaying a project and incurring additional costs to preserve patient satisfaction and safety. But just how does one achieve that when needing to shut down medical gas, wastewater flow, or even entire hospital wings or floors?

From mitigating interference to planning and communication, following are considerations to reduce interference and keep patient care at the forefront during your next medical center renovation or expansion.

Plan, Plan, Plan

More than one-third of all hospitals polled in the ASHE 2019 Hospital Construction Survey currently have facilities projects under construction, which means constantly moving parts and reduced capacity at one out of every three hospitals at any given time. Thus, ensuring a successful renovation project involves planning beyond the construction itself.

“Understand that design informs operations, and operations inform design,” said Michael Hagan, AIA, associate principal at TreanorHL. When hospitals face a renovation, they are often losing a room, a piece of equipment, and even walls yet need to maintain the same standard of care.

“Every project, regardless how small, impacts operation,” said Hagan, who is leading the design team of St. Joseph Hospital’s Neonatal Intensive Care Unit/Labor and Delivery expansion. As its Clinical Manager Sara Griffin said, “This is a sensitive population – premature infants. We need to be conscious about what we might do that effects long-term outcomes.” Particularly in the NICU, things like infection control are of the utmost importance, so much that it played a large role in contractor selection. “In sensitive areas like that, we have to consider things like materials and process training; it’s not just about construction,” said Hagan. “Your team needs to be cognizant that there is a patient next door. You can’t eat lunch in that space, and you have to watch your language.”

“From engineers to contractors to consultants, aligning the entire team is a tremendous factor in project success. There’s value in selecting right team, and that doesn’t always mean they’re the cheapest,” said Justin Franklin, senior director at FTI Construction Solutions. “If you have a team you trust, whom you can communicate with, collaborate with, and have professional disagreement with, where there’s humility – there’s value in that. Technology is great, but it’s just a tool. If you have broken communications or relationships, a piece of tech will not improve a project; you have to have the communication line open.”

Communicate and be Inclusive

When it comes to ensuring patient safety, there’s no such thing as too much communication – with everyone from the top down, as clinicians have different expectations than those in the C-suite. “Sometimes a wall has to go out and it has to be in a specific spot,” said Griffin. “My biggest concern is knowing that it’s happening and how it will affect the flow of families getting to the NICU or getting a patient out. My job is to plan for what that looks like and educating people on it.”

Franklin involves stakeholders from every department on a regular basis to identify the extent of the impact, with everything from the best time for certain work, when power will be killed to specific devices, and even details down to extension cords. “Make sure every party is involved and that there are no surprises,” he said. “The last thing we want to do is surprise a surgeon or a patient.”

In addition, engaging staff at all levels early on is key.

“Look at patient satisfiers and identify those in the expansion,” said Biesk. “Get them excited about the project. Share boards and plans and renderings, because if they don’t have stake in process, they won’t feel included.” Franklin agreed, “It creates a feeling of ownership during the design process. That ownership helps with that and makes it a more enjoyable process.”

During the renovation of imaging and radiology at Lutheran Medical Center, staff members were able to post photos and messages on a temporary wall to maintain morale during construction. “You don’t ever want someone to feel isolated or that their input is not valid,” said Hagan. He recommends working as a team with users to determine alternative paths and develop mailers, maps and communications tools. “Get your end users involved,” said Griffin. “Listen to what they have to say so that it’s functional when you are all gone and done.”

At the end of the day, Hagan’s biggest advice is to avoid being reactive and get everyone on board. “It is the collaborative team – together – who works toward a positive outcome and successful project,” he said. “No one project, firm or department can make that happen. We’re partners in the process.”

Featured in the October issue of Health Care Properties Quarterly